IHS Leadership Fails to Explain Budget Needs

If there is a poster child in Indian country for All that can go wrong will go wrong, it is IHS, with the BIE or BIA running a close second. On July 12, during the final budget hearing for the FY2018 Budget Request for Indian Health Service, newly appointed Acting Director of Indian Health Service (IHS), Rear Admiral Michael Weahkee, did little to change that image.

In front of the Subcommittee on the Department of the Interior, Environment, and Related Agencies of the United States Senate Committee on Appropriations, committee members nearly drew blood questioning a continually retreating Weahkee as he failed in a way rarely witnessed on the Hill to defend the FY2018 IHS budget.

Weahkee, who is responsible for the health of 2.2 million American Indians and Alaska Natives in the 567 federally recognized tribes in 36 states, was unable or unwilling to explain or defend what Chairwoman Lisa Murkowski (R-AK) characterized as a $300 million cut in the already meager $4.7 billion IHS budget.

“I am very concerned that the budget request does not adequately meet the needs for health care in Indian country,” Murkowski said. Given the disproportionate rates of diabetes, drug-related deaths, and suicides, and vacancy rates for physicians dentists, and physician assistants nearing 30 percent, and a half a billion dollar backlog in facilities maintenance to address, the math simply did not add up.

As recently as June 13, the Senate Committee on Indian Affairs (SCIA) had devoted two full hours to S.1250, the Restoring Accountability in the Indian Health Service Act, where then Acting Director of IHS, Rear Admiral Chris Buchanan, got a similar drubbing. At that meeting, as Sen. Jon Tester (D-MT) put it, “IHS has been a failure, frankly,” with Sen. John Thune (R-SD) piling on with, “IHS continues to underperform.”

By almost any account it has—inadequate funding, poor federal and tribal management, lines of patients out the door, patients waiting interminably for service, and a standard of care that falls far short of the national average. And it didn’t help that in February the Government Accountability Office identified IHS as one of three programs “at risk” in its annual High-Risk Report either.

Fast forward to the July 12 meeting, and that much needed reality check which comes in the form of the annual budget drill.

Clear from all witnesses at the June 13 meeting was that the 30 percent vacancy in critical clinical staffing including physicians and physician assistants was the key driver in poor IHS service. On July 12, Weahkee agreed with that assessment. But according to Tester’s press release following the July 13 hearing, “Tester specifically asked Weahkee seven times if the President’s proposed budget increased or decreased the funding for health care workforce recruitment and retention at Indian Health Service facilities,” which Weahkee refused to answer. Seven times. To the point where Tester asked him whether Weahkee had been told not to answer any questions at the hearing, which Weahkee denied.

Weahkee was also unable—or unwilling—to provide a detailed accounting of how the budget had been devised, at which point Tester essentially accused him of incompetence.

“…I think it is absolutely unbelievable that you can’t separate how much money Medicaid has helped you with third-party billing. I mean, to the point where I think we should almost demand an audit.”

Weahkee’s response was, “I have been able to leverage a lot of work that’s been done prior.” That was about the strongest response that Tester got, with all other direct questions answered evasively, which irked Tester, to say the least.

“I have never had, in ten years on this committee, I have never had somebody come up here and when I ask them a direct question, they don’t answer it. I asked you a direct question on whether this budget was up or down and you would not answer it, you refused to answer it. That is totally unacceptable. I did not come in here with my hair on fire, but I am leaving here with it. I am going to tell you something, Indian health services is in a crisis… I cannot believe what has transpired in this hearing today.”

In fairness to Weahkee, he is new to the job, although decidedly not new to the issues. Moreover, he had Rear Admiral Chris Buchanan, now the Deputy Director for the IHS, Gary Hartz, the Director of the Office of Environmental Health and Engineering, and Elizabeth Fowler, the Deputy Director for Management Operations to shore him up. But even his written testimony was dodgy, comparing most FY2018 funding to maintaining the FY2016 levels, while counting on third-party payments from Medicare, Medicaid, the Veterans Administration, and the ACA—all on the chopping block in the Senate as of July 25, 2017—to cover at least $1.2 billion of the funding.

IHS has not responded to inquiries from ICMN about Weahkee’s budgetary testimony.

What is clear is that Congress now has precious little time to debate a FY2018 budget before the new fiscal year begins on October 1, leaving IHS to operate on the FY2018 continuing resolution.

Yet the crisis in Indian healthcare will proceed. In the words of Victoria Kitcheyan, Treasurer of the Winnebago Tribe of Nebraska, in the June 13 session, “Congress cannot continue to starve the Indian health system and expect major change.”